Women Can Rely on Own Bodies

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Many women seeking breast reconstruction as part of a mastectomy to treat or prevent cancer can use their own body's tissue for breasts that are comparable in appearance and touch to their original breasts, according to R. Michael Koch, MD, a board certified plastic and reconstructive surgeon with the New York Group for Plastic Surgery specializing in microsurgery. Using self-donated tissue to create breasts — known as an autologous breast reconstruction or free tissue transfer —is an alternative for women who may not want implants and have adequate fat reserves to construct the new breasts.

"There's a positive trend for women facing mastectomy for breast cancer treatment or prevention due to high genetic or familial risk to take more control over how their breasts are reconstructed, and increasingly that includes using their own body's tissue instead of implants to attain breasts with a more natural form," said Dr. Koch. "More women are also opting for nipple-sparing mastectomy and immediate reconstruction at the time of mastectomy, which can frequently be accomplished with autologous breast reconstruction."

Autologous breast reconstruction, also known as free tissue transfer, is performed by a plastic surgeon specializing in microsurgery. An area of skin, fat and blood vessels, referred to as the "tissue flap," is surgically taken from a designated area of the body, typically the abdomen. A type of free tissue transfer called DIEP (deep inferior epigastric perforator) allows the surgeon to lift the tissue without taking any abdominal muscle within the donated tissue area, so that a woman's core stomach strength is not impacted.

The tissue flap is transferred into the breasts to fill up the skin envelope after all breast tissue was removed during the mastectomy. In order for the flap to survive in its new location, a microscope and precision instruments are used to reattach the abdominal blood vessels to the blood vessels in the breast area.

Both autologous and breast implant reconstruction have benefits and downsides, with the choice unique to each woman facing mastectomy and reconstruction.

"Using her own body's tissue offers a woman breasts that look and feel incredibly natural, with the added benefit of excess abdominal fat removal," Dr. Koch said. "But the autologous reconstructive surgery is more complex and the recovery period is typically longer than with breast implant reconstruction. The decision for each woman generally comes down to her goals for surgery, recovery and aesthetic outcome, and of course which procedure will best suit her body type for optimal results."

Dr. Koch noted that a significant consideration in the decision to proceed with autologous breast reconstruction is a patient's smoking habit, as smoking constricts blood vessels and makes them ineligible for a successful and sustainable transfer from one area of the body to another. He emphasized that the skill and experience of the microsurgeon is critical to the success of autologous breast reconstruction following mastectomy, as risks can include breasts that are asymmetrical, or uneven; excessive scarring at the donor tissue area; and failure to preserve the nipple area, otherwise known as necrosis, in a nipple-sparing mastectomy.

"A woman has the right and an obligation to herself to ask the microsurgeon questions about his or her expertise and how many autologous breast reconstructions they've successfully performed," Dr. Koch said. "Seek a second or even third opinion until you find the right fit for both the breast reconstruction procedure and the surgeon who will perform it."